In a study that could have national significance, the Oklahoma State Department of Health (OSDH) recommends that a standard for prenatal care that is followed by all prenatal care providers is necessary to ensure that all women receive the same high quality care necessary to reduce stress during pregnancy and ensure healthier outcomes for mothers and infants.

After reviewing findings of its Pregnancy Risk Assessment Monitoring System (PRAMS) survey on prenatal care, the OSDH Maternal Child Health Service recommends that not only the prenatal care number of visits be monitored, but that the content of those visits be monitored to assure a standard for quality of care given during prenatal care visits with a health care provider.

Oklahoma’s study plows new ground in an area where little research has been done in the past 15 years. In the few studies that have been done at a national level, racial and ethnic disparities have been documented when examining the content of prenatal care visits.

“National studies have found that adequate prenatal care as traditionally measured by visits alone, does not reduce the disparities in healthy outcomes between African American and white women,” said OSDH Interim State Health Officer Dr. Edd Rhoades. “Comprehensive prenatal care counseling is very important during pregnancy.”

The major findings of the Oklahoma PRAMS study indicate the following:

· Only 15 percent of all Oklahoma women received counseling on all of the 16 measured prenatal care topics.

· African American mothers were more likely to receive guidance on illegal drug use and physical abuse and less likely to receive information on the appropriate amount of weight to gain when compared to white women.

· Topics women were least likely to receive counseling on – independent of race – were seat belt use during pregnancy, postpartum depression, physical abuse during pregnancy, and pregnancy spacing.

· While maternal smokers were very likely (over 80 percent) to receive discussions about the effects of smoking during pregnancy, less than 15 percent were then referred to the Oklahoma Tobacco Helpline at 1-800-Quit-Now. Tobacco use is a known contributor to low birth weight and infant death.

· Fewer than 10 percent of women smoking during pregnancy were prescribed an inhaler, pill, spray or patch to aid them to quit smoking even though programs existed to provide them at low or no cost.

· Women who needed counseling about physical abuse, who reported abuse before or during pregnancy, were marginally more likely to receive it if they were white. However, fewer than 45 percent of women in both groups recalled discussing the issue of domestic violence with their providers. Violence before and during a pregnancy can increase a woman’s risk for delivering a low birth weight infant or increase the likelihood of stillbirth or infant death.

Receiving the appropriate prenatal care counseling from a physician or other health care provider may encourage women to make changes that will positively impact the health of their pregnancy. And by creating and ensuring a standard level of quality prenatal care in the state all women will begin pregnancy with the same tools to begin building their healthy families. The OSDH recommends the following actions based upon the PRAMS findings of this study:

1. Provide consistent prenatal care to all women based on recommended standards of care such as those from the American College of Obstetricians and Gynecology to ensure that all necessary topics will be discussed.

2. Create incentives for providers for standard of care practices like using a prenatal care standardized tool from state insurance providers.

3. Improve customer service skills for front office staff, nurses, and physicians to create welcoming environments for patients of all ethnic backgrounds taking into consideration the cultural differences involved.

4. Review promising practices in this state and others that reduce disparities in health outcomes between white and African American women and provide evidence-based pregnancy related care.

5. Fully fund and implement programs like Children First and Healthy Start in Oklahoma. These are evidence-based programs that provide in-depth education on pregnancy-related issues and create personal relationships between health providers, pregnant and parenting women.

6. Refer all pregnant women who use any form of tobacco to the free Oklahoma Tobacco Helpline at 1-800-Quit-Now.

7. Conduct research of women with good pregnancy and birth outcomes to see how they differ from women with poor outcomes to determine what they do differently and which factors assist in positive outcomes for African American women so results can be shared.

8. Institute standard guidelines or tools for before pregnancy (preconception) and during and between pregnancies (interconception) care for all women. A tool is being developed by OSDH for suggested use by all providers of health care for women and men of childbearing age.

PRAMS is an ongoing population-based study designed to collect information about maternal behaviors and experiences before, during and after pregnancy. To read the entire report, go to http://mchs.health.ok.gov and click on “Data and Evaluation” to find PRAMS reports. For information about health before, during and after pregnancy, contact your county health department or the OSDH MCH Service at (405) 271-4476.